PY 2025 Pennie Individual Marketplace Training for New Agents and Brokers Practice Test

Filing an appeal regarding a bill from an out-of-network provider should be done with the insurer because they are responsible for reviewing and making decisions on claims related to their coverage. The insurer has the necessary information and authority to assess the circumstances of the claim and determine whether the service provided is covered under the individual's health plan, even if the provider is out-of-network.

The process often involves the customer contacting their insurer directly, providing the relevant documentation and information about the situation. The insurer will then evaluate the claim based on the specifics of the policy, which may include details on out-of-network coverage. This makes the insurer the appropriate entity to handle such appeals, ensuring that the customer's concerns are addressed in accordance with the terms of their health plan.

In contrast, while the other options may involve support and guidance related to insurance matters—such as general advice from brokers or assisters or oversight from state healthcare offices—they do not have the direct ability to adjudicate or resolve claims related to insurance coverage.